高血压病患者血尿酸水平观察及氯沙坦对血尿酸的影响

目的 观察高血压病患者血尿酸(UA)水平及氯沙坦对UA的影响.方法 将120例患者随机分为氯沙坦组(试验组)和缬沙坦组(对照组),每组60例,观察治疗前、后UA变化.结果 ①高血压1、2、3级患者UA分别为(279.28±95.27)μmol/L、(312.63±83.57)μmol/L和(451.03±72.73)μmol/L,高血压3级患者UA明显高于1级和2级患者(P<0.01);②氯沙坦组治疗后UA水平显著降低(P<0.01),缬沙坦组治疗前、后差异无统计学意义(P>0.05).结论 高血压患者UA水平与血压水平相关.氯沙坦具有降UA作用,而缬沙坦无降UA作用.     

正常高值血压患者尿酸与C-反应蛋白的相关性研究

目的:研究正常高值血压患者随血压的升高尿酸与C-反应蛋白(CRP)之间的关系,并探讨其临床意义。方法:184例根据血压分成3组,正常高值血压高组(高值高组)[130～139/85～89mmHg(1mmHg=0.133kPa)]65例,正常高值血压低组(高值低组)(120～129/80～84mmHg)59例,正常血压(正常血压组)(<120/<80mmHg)60例,分别检测血尿酸与CRP。结果:高值低组尿酸与CRP明显高于正常组(P<0.05,P<0.01),高值高组尿酸与CRP明显高于高值低组(P<0.05,P<0.01),并且高值低组与高值高组的尿酸与CRP升高具有相关性,高值高组的相关性又明显高于高值低组,正常血压组两者之间无相关性。结论:尿酸与CRP是高血压的危险因素,两者之间的相互作用加重了高血压的发展。     

青岛市正常高值血压及高血压人群现况和全身血管损伤情况

目的探讨青岛地区正常高值血压及高血压人群患病情况及全身血管损伤情况。方法对青岛市30岁以上人群进行横断面调查,调查内容包括基本情况、血压、临床生化指标检测、尿白蛋白肌酐比值(UACR)、肱踝脉搏波传导速度(ba PWV)、网膜中央动脉直径(CRAE)及合并心血管危险因素情况。结果 4 346名调查者中,正常高值血压1 165人(26.8%),高血压1 739例(40.0%),男性高血压患病率44.8%,女性36.8%,30~39岁人群高血压患病率9.7%,40~49岁22.4%,50~59岁42.1%,60~69岁(63.2%),≥70岁74.6%。正常高值血压组与高血压组人群年龄、体重指数(BMI)、腰围、收缩压、舒张压、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、尿酸(UA)水平均高于正常血压组,高血压组均高于正常高值血压组(P<0.05)。高血压组合并3种及≥4种危险因素人数比例高于正常高值血压组及正常血压组(P<0.05)。高血压组UACR、ba PWV、CRAE异常率高于正常高值血压组及正常血压组(P<0.05)。多因素Logistic回归分析发现,正常高值血压及高血压均是UACR、ba PWV、CRAE的独立危险因素(P<0.05)。结论青岛市男性高血压患病率高于女性,随着年龄增长,高血压患病率呈不断上升趋势,正常高值血压人群及高血压人群均合并有多种代谢异常及多种心血管疾病危险因素,且已经发生血管损伤,应加强对正常高值血压人群及高血压人群的健康教育,积极控制血压,降低心脑血管事件发生率。     

正常高值血压及其合并的传统危险因素与同型半胱氨酸的关系

目的 探讨同型半胱氨酸（Hcy）与正常高值血压（高血压前期）及其合并的传统危险因素之间的关系,以利于早期干预血压进展和靶器官损害.方法 随机选取我院体检中心正常高值血压者300例为研究组;选择107例同期健康体检血压正常者为对照组.计算体重指数（BMI）,测定空腹血糖（FPG）、血清总胆固醇（CHO）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、血红蛋白（Hb）、尿酸（UA）和Hcy（酶法）,并做比较和相关性分析.将正常高值血压组进一步分为正常高值血压合并高血糖组和正常高值血压合并代谢综合征组,并做组内比较.结果 正常高值血压组血清Hcy显著高于对照组[（18.03±11.13）μmol/L比（13.21±5.81）μmol/L]（P〈0.05）.Hcy与血压、BMI、TG、UA、Hb呈正相关,与HDL-C呈负相关,与年龄、FPG、CHO、LDL-C无关联,且存在性别差异（男性〉女性）.正常高值血压组组内比较Hcy差异无统计学意义.结论 ①正常高值血压者Hcy水平高于正常血压者,且血清Hcy浓度越高,血压水平和尿酸越高.检测Hcy有利于早期干预血压进展和靶器官损害.②合并的传统危险因素并不增加Hcy,Hcy与进一步增加的心血管危险无直接相关.     

高血压前期与血尿酸及血脂相关性调查

目的:探讨高血压前期(120~139/80~89mmHg)与血尿酸(UA)及血脂的相关性。方法:本院体检中心查出的高血压前期患者242例,年龄30~50岁,其中男184例,女58例;血压正常者386例30~50岁,其中男311例,女75例。测全部对象的血尿酸及血脂并进行比较。结果:高血压前期组血尿酸含量[UA(265±85)μmmol],甘油三酯(TG)[(2.2±1.6)μmmol/L],总胆固醇(TC)[(4.6±0.9)μmmol/L],低密度脂蛋白-胆固醇/高密度脂蛋白-胆固醇(LDL-C/HDL-C)比值(1.7±0.4),显著高于对照组的UA[(220±64)μmmol/L],TG[(1.8±1.8)μmmol/L],TC[(4.3±0.7)μmmol/L],LDL-C/HDL-C(1.5±0.6),P均<0.01。相关性分析显示:高血压前期者的血压与UA,TG,TC呈正相关(r=0.142,0.138,0.156,P<0.05)。结论:高血压前期者已有血尿酸和血脂异常变化,应该及时进行干预,预防高血压的发生,并减少费用。     

Graves病患者血尿酸水平与腰椎骨密度的关系

目的探讨Graves病(GD)患者血尿酸(UA)水平与腰椎骨量的关系。方法选取72例GD患者和39例甲状腺功能及UA水平均正常的体检者(正常对照组)为研究对象,GD患者进一步按UA水平分为高尿酸血症组和UA正常组,测定相关生化指标,并用双能X线骨密度仪(DEXA)测定腰椎正位骨密度,比较不同组别间腰椎骨密度水平、骨量减少及骨质疏松(OP)(统称骨量丢失)发生率的差异,分析GD组影响腰椎骨量的主要危险因素。结果 GD伴高尿酸血症组以及GD伴UA正常组UA、TT3、TT4、FT3、FT4、血钙(Ca)、血磷(P)、碱性磷酸酶(ALP)、血清骨特异性ALP(Ostase)均高于正常对照组(P<0.01),而体重指数(BMI)、TSH、肌酐(Cr)、总胆固醇(TC)、血25羟基维生素D(OH)D、腰椎骨密度(BMD)则均低于后者(P<0.01);GD伴高尿酸血症组TT4、FT3、UA、Cr、ALP、Ostase水平显著高于GD伴UA正常组(P<0.05或0.01),而腰椎BMD则显著低于后者(P<0.01)。GD伴高尿酸血症以及GD伴UA正常者骨量减少及OP发生率显著高于正常对照组(P<0.05),而GD伴高UA症组骨量减少发生率显著高于GD伴UA正常组(P<0.05)。二分类Logistic回归分析显示,年龄(OR=1.112,P=0.024)、TT4(OR=1.138,P=0.051)及UA(OR=1.015,P=0.013)为GD患者腰椎骨量丢失的独立危险因素。结论 GD患者UA水平增高,GD伴高UA症者更易发生腰椎骨量丢失,而UA增高是引起GD患者腰椎骨量丢失的主要危险因素之一。     

正常高值血压者动脉血压昼夜节律与血管内皮功能及颈动脉内膜中层厚度的关系

目的了解正常高值血压动态血压昼夜节律及血管内皮功能(FMD)、颈动脉内膜中层厚度(IMT),探讨三者之间的关系。方法连续收集2010-08-12湘雅医院体检中心正常高值血压者104例,根据动态血压昼夜变化规律分为杓型组(55例)和非杓型组(49例),健康体检者40例为对照组。高分辨超声检测肱动脉FMD及颈动脉IMT。结果正常高值血压动态血压呈杓型及非杓型各占52.9%及47.1%,杓型组与非杓型组的IMT大于对照组[(0.74±0.06)、(0.75±0.06)比(0.47±0.05)mm],FMD值小于对照组[(8.07±1.18)%、(5.89±0.93)%比(13.78±1.98)%,均P<0.05],其中杓型组FMD大于非杓型组。FMD与IMT呈负相关(r=-0.843,P<0.01)。结论正常高值血压者存在血压节律异常、IMT增厚及FMD减退,动态血压呈非杓型者FMD损害较杓型者更严重。     

心力衰竭患者血清脑利钠肽浓度变化及其意义

目的:探讨充血性心力衰竭(CHF)患者血清脑利钠肽(BNP)浓度变化及其临床意义。方法:选择76例CHF患者(CHF组),32例有呼吸困难的非CHF患者(非CHF组)及30例健康成人(对照组),超声心动图测定左室射血分数(LVEF),酶联免疫吸附法(ELISA)检测血清脑利钠肽(BNP)水平。比较各组血清BNP水平,并动态观察NYHA级、级患者治疗二周后BNP水平变化。结果:(1)心衰组BNP水平(853.6±258.3ng/L)明显高于有呼吸困难的非CHF组(110.1±22.4ng/L)及正常对照组(105.1±21.2ng/L),P<0.01,以113.0ng/L为正常上限值,BNP诊断CHF的灵敏度为100%,特异度为85.5%;(2)NYHA级、级和级的BNP水平分别为615.4±171.0ng/L、837.2±166.1ng/L和1025.7±252.8ng/L,组间比较P<0.01,BNP与左室射血分数呈负相关(r=-0.920,P<0.01);无效者治疗后BNP水平显著高于治疗前。结论:血清脑利钠肽(BNP)浓度有助于心衰的诊断,鉴别诊断和疗效评价。     

血清胱抑素C在妊娠期高血压早期肾损害中的意义

目的 评价血清胱抑素C(CysC)在妊娠期高血压(GH)早期肾损害中的意义.方法 收集GH患者40例、正常妊娠妇女70例(其中早中期妊娠35例,晚期妊娠35例)和30例正常对照者血清,以颗粒增强散射比浊法测定CysC、β2微球蛋白(β2-M),以生化分析法测定尿素氮(BUN)、血肌酐(SCr)、尿酸(UA)含量,并加以比较. 结果 正常血压晚期妊娠组(1.22±0.19)mg/L与GH组(1.93±0.48)mg/L的CysC水平均明显高于健康体检组[(0.78±0.22)mg/L,P＜0.05和P＜0.01];同时,GH组CysC水平高于正常血压晚期妊娠组(P＜0.05);正常早中期妊娠组CysC水平与正常对照组无明显差异;GH组CysC水平与UA呈正相关(r=0.46, P＜0.05).结论 血清CysC是评价妊娠期高血压早期肾功能损害的一项敏感和可靠的指标.     

雄性自发性高血压大鼠代谢综合征相关指标及药物干预的研究

目的:探讨早期雄性自发性高血压大鼠(SHR)血清尿酸(UA)和血脂代谢异常在高血压靶器官损害进程中的作用,并观察厄贝沙坦(irbesartan)对血尿酸和血脂代谢的影响。方法:对象为15周龄雄性SHR20只和正常雄性同龄WistarKyoto(WKY)大鼠10只。将SHR随机分为两组:厄贝沙坦治疗组(按厄贝沙坦50mg/kg.d从饮水给药);SHR阳性对照组。后者与WKY正常对照组喂以等量蒸馏水代替。实验于三个月后停药,测体重和血压,检测血清UA、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)值。结果:实验三个月后,与WKY组比较,SHR组UA水平显著增高(P<0.05),血压和TG水平显著增高(P<0.01);与SHR组比较,厄贝沙坦组血压和TG水平显著降低(P<0.01),UA水平显著降低(P<0.05)。结论:高血压病早期已经存在着高尿酸血症和血脂异常等代谢异常的临床征象,厄贝沙坦既具有降低TG又具有降低UA的作用,可能有抗动脉粥样硬化和肾保护作用。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.